Methods and devices for removing tissue from a patient

ABSTRACT

The present invention is directed to tissue removal devices and methods. A tubular element having an open distal end is advanced into tissue so that tissue enters the tubular element. The tissue which entered the tubular element is cut to separate the tissue from the surrounding tissue. The tissue is then transported proximally by the cutting element or a separate transport element.

BACKGROUND

The present invention is directed to tissue removing devices andmethods. The invention may be used to remove tissue from any part of thebody and is particularly useful in removing tissue from the breast. Ofcourse, the invention may be used in any other part of the body and usein the breast is merely exemplary.

SUMMARY

In a first aspect of the present invention, a tissue removal device isprovided which has a tubular element, a transport element and a cuttingelement. The tubular element has an open distal end. The transportelement and the cutting element are positioned at least partially withinthe tubular element and are movable within the tubular element. Thedevice is introduced into a patient and the tubular element is advancedso that tissue enters the tubular element through the open end. Thecutting element is then used to cut or part-off the tissue which hasentered the tubular element and the transport element is used totransport the tissue proximally to a tissue chamber.

The transport element may take many forms. In one embodiment, thetransport element has an open end positioned proximal to the open end ofthe tubular element so that tissue enters the open end of the transportelement when the tubular element is advanced into tissue. The transportelement may also pierce the tissue being removed from the patient.Furthermore, the transport element may have a deployable anchor whichsecures the tissue to the transport element. The anchor may take anysuitable shape such as deployable barbs, wires or an inflatable balloon.

In another aspect of the present invention, the device may include acutting element which parts off the tissue which enters the tubularelement and also transports the tissue to the tissue chamber. Thecutting element may have a first part and a second part which movetoward one another to a cutting position when cutting the tissue withinthe tubular element. The cutting element may be plastically deformedwhen moving to a cutting position.

These and other aspects of the present invention shall become apparentfrom the following description, drawings and claims.

DESCRIPTION OF DRAWINGS

FIG. 1 shows a tissue removing device in accordance with the presentinvention.

FIG. 2 shows another view of the device of FIG. 1.

FIG. 3 is a cross-sectional view of a distal end of the tissue removaldevice with a cutting element in a stored position.

FIG. 4 is a cross-sectional view showing the cutting element in acutting position.

FIG. 5 shows the device being introduced into tissue.

FIG. 6 shows an introducer withdrawn from the distal end.

FIG. 7 shows a tubular element advanced into tissue.

FIG. 8 shows a cutting element cutting tissue which has entered thetubular element.

FIG. 9 shows the tissue being transported proximally.

FIG. 10 shows the tissue positioned over a tissue chamber and contactinga distal end of the introducer.

FIG. 11 shows the tissue falling into the tissue chamber.

FIG. 12 is a cross-sectional view of another tissue removal device.

FIG. 13 shows the device of FIG. 12 introduced into tissue.

FIG. 14 shows the introducer retracted.

FIG. 15 shows the cutting element being advanced distally.

FIG. 16 shows the cutting element in a cutting position.

FIG. 17 shows the cutting element moving the tissue proximally towardthe tissue chamber.

FIG. 18 shows the tissue being released into the tissue chamber by thecutting element.

FIG. 19 shows another device for removing tissue from a patient.

FIG. 20 shows the cutting element cutting the tissue which has enteredthe tubular element.

FIG. 21 shows still another device for removing tissue from a patient.

FIG. 22 shows another anchor for the device of FIG. 21.

FIG. 23 shows still another anchor for the device of FIG. 21.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

Referring to FIGS. 1-11, a tissue removing device 2 according to thepresent invention is shown. The devices and methods described herein maybe used to remove tissue from any location in the body and an example ofsuch a use is removal of tissue from the breast as described below. Thetissue removal device 2 has a tubular element 4 which is advanced intotissue so that tissue is received through an open end 6 of the tubularelement 4. A transport element 7 is positioned within the tubularelement 4 and is used to transport tissue back to a tissue samplechamber 30 as described below.

The distal end of the tubular element 4 is beveled to form a sharp tip11 but may take any other suitable configuration which penetratestissue. The tubular element 4 may also be rotated when driven into thetissue. The tubular element 4 may be made of any suitable material suchas stainless steel. The device 2 may also include an introducer 20positioned in the tubular element 4 during introduction. The introducer20 may have a sharp tip 22 which penetrates the tissue duringintroduction of the device 2 as shown in FIG. 5. The device 2 may alsobe introduced through a sheath, trocar or cannula (not shown) whichpenetrates the tissue rather than using the device 2 itself to penetratethe tissue.

Although the present invention may be used to collect tissue of anysize, the invention is particularly useful in removing relatively smallquantities of tissue such as required in breast biopsies. When used forthis purpose, the inner diameter of the device 2 may be less than 5 mmor even less than 3.5 mm. The present invention provides the ability toobtain small, cylindrical tissue samples which are relativelyundisturbed compared to many prior art solutions. The tubular element 4may be driven forward a distance of 15-25 mm which may be selected bythe user.

The tissue removal device 2 also has a cutting element 10 which is usedto cut or “part off” tissue which has entered the tubular element 4 fromthe surrounding tissue. The cutting element 10 is stored between thetubular element 4 and the transport element 7 and naturally assumes theposition of FIG. 4 when advanced. The cutting element 10 also contacts aprotrusion 11 on an inner surface 13 of the tubular element 4 whichdirects the cutting element 10 into the cutting position of FIG. 4. Theprotrusion 11 may simply be a ring 15 of material attached to the innersurface of the tubular element 4 although any other structure may beused. The transport element 4 and cutting element 10 are then movedproximally to the tissue chamber with the cutting element 10 remainingin the cutting position of FIG. 4 as explained below.

The tissue removal device 2 has a first actuator 24 and a secondactuator 26 which are described further below in connection with use ofthe device 2. When the first actuator 24 is depressed, the introducer 20is retracted proximally to the position shown in FIG. 6 so that the openend of the tubular element 4 is exposed to receive tissue. When thesecond actuator 26 is depressed, the tubular element 4 is driven forwardso that tissue enters the open end 6. The cutting element 10 is thenautomatically advanced to part off tissue which has entered the open end10 and the transport element 7 then transports the tissue to the tissuechamber 30. The first and second actuators 24, 26 may be knobs, buttons,levers or triggers and FIGS. 1 and 2 show the first and second actuators24, 26 being buttons.

Use of the tissue removal device 2 is now described in connection withFIGS. 5-11. The device 2 is introduced into the patient for removal oftissue such as breast tissue in a breast biopsy procedure. The device 2is introduced directly into the tissue with the sharp tip 22 of theintroducer 20 penetrating tissue as shown in FIG. 5. The device 2 mayalso be introduced into the patient through a sheath, trocar or cannula(not shown). Once the distal end is positioned proximal to the tissue tobe removed, the first actuator 24 is depressed to withdraw theintroducer 20 and expose the open end 6 as shown in FIG. 6. Afterretracting the introducer 20 the user may, of course, manipulate thedevice 2 as necessary so that the device 2 is directed toward the tissueto be removed. The introducer 20 may be withdrawn to a position proximalto the tissue chamber 30 or another suitable position.

The second actuator 26 is then depressed which causes the tubularelement 4 to be driven forward so that tissue enters the open end 6 asshown in FIG. 7. The transport element 7 may be advanced with thetubular element 4 or may be driven independently of the tubular element4 without departing from the invention. For example, the transportelement 7 may be driven into the position of FIG. 7 after the tubularelement 4 has been driven into the tissue and even after the cuttingelement 10 has been deployed to the position of FIG. 8. The tubularelement 4 may also be rotated while being driven forward, for example,the tubular element 4 may be rotated 0.5 to 3 revolutions when drivenforward. The tubular element 4 may also simply be translated (withoutrotating) without departing from numerous aspects of the presentinvention. The introducer 20 may be advanced with the tubular element 4as shown in FIG. 7.

The cutting element 10 is then advanced until it contacts the protrusion11 and is directed into the tissue which has entered the tubular element4 as shown in FIGS. 4 and 8. The cutting element 10 extends toward andthrough a longitudinal axis defined by the tubular element 4 and formsan angle of about 70 degrees with the longitudinal axis although anyother suitable angle may be used. The cutting element 10, transportelement 7 and/or tubular element 4 may also be rotated to aid in cuttingthe tissue. The cutting element 10 may be rotated with the tubularelement 4 in the same direction or in opposite directions when partingoff the tissue which has entered the device 2.

The transport element 7 and cutting element 10 then move proximallytoward the tissue chamber 30 as shown in FIG. 9. The introducer 20 ispositioned so that continued proximal movement of the transport element7 brings the tissue into contact with the distal end of the introducer20 as shown in FIG. 10. Continued proximal movement of the transportelement 7 completely exposes the tissue and permits the tissue to fallinto the tissue chamber 30 as shown in FIG. 11. The tubular element 4has an opening 32 leading to the tissue chamber 30 to permit the tissueto fall into the tissue chamber 30 when the tubular element 4 is in theposition of FIG. 11.

The cutting element 10 is straightened by withdrawing the cuttingelement 10 into a recess (not shown). The cutting element 10 andtransport element 7 are then moved back to the position of FIG. 6. Thetubular element 4 may remain within the patient during transport of thetissue to the tissue chamber 30 so that the device 2 is ready to takeanother tissue mass without removing the device 2 from the patient. Theuser may re-orient the device 2 as necessary so that the tubular element4 is directed at tissue to be removed. The user then actuates the secondactuator 26 again which causes the tubular element 4 to be drivenforward to collect another tissue mass. If a tissue mass is desired atanother location, the user may actuate the first actuator 24 to move theintroducer 20 back to the position of FIG. 5. The device 2 may then bemanipulated to position the device 2 at the next location where tissueis to be removed.

Referring to FIGS. 12-18, another device 2A for removing tissue is shownwherein the same or similar reference numbers refer to the same orsimilar structure. The cutting element 10A has a first part 40 and asecond part 42 which may be integrally formed or may be independentelements. The first and second parts 40, 42 move inwardly to cut thetissue which has entered the tubular element 4 as shown in FIG. 12. Thefirst and second parts 40, 42 move inwardly when they engage aprotrusion 44 on an inner wall 46 of the tubular element 4A as shown inFIG. 12. The protrusion 16 may be a ring 21 which directs the first andsecond parts 40, 42 inwardly.

The first and second parts 40, 42 may each include a portion 50 whichundergoes plastic deformation when moving to the position of FIG. 12.The first and second parts 40, 42 remain in the closed position untilthey are withdrawn into recesses (not shown) which straighten the twoparts 40, 42. The first and second parts 40, 42 may also lock togetheror may be naturally biased to the position of FIG. 12 rather than beingplastically deformed without departing from numerous aspects of thepresent invention.

The cutting element 10A is used to transport then tissue to the tissuechamber 30 after parting off the tissue. The cutting element 10A movesproximally as shown in FIGS. 17 and 18 to transport the tissue to thetissue chamber 30. The tissue may contact the introducer 20 or anotherpart of the device 2A as the tissue is moved proximally to help releasethe tissue from the cutting element 10A.

Use of the device 2A is similar to use of the device 2 described above.The first actuator 24 is depressed to retract the introducer 20 as shownin FIG. 14. The second actuator 26 is then depressed which causes thetubular element 4A to be advanced into tissue as shown in FIG. 14. Thecutting element 10A is then advanced to part off the tissue whichentered the open end as shown in FIGS. 12 and 16. The cutting element10A may be moved together with the tubular element 4A when the tubularelement 4A is advanced or may be driven over the tissue after the tissuehas entered the tubular element 4A. The cutting element 10A then movesproximally toward the tissue chamber 30 as shown in FIG. 17 and depositsthe tissue in the tissue chamber 30 as shown in FIG. 18. The first andsecond parts 40, 42 are opened when they are withdrawn into the recesses(not shown).

The tubular element 4A and cutting element 10 are then moved back intoposition to take another tissue mass. As such, the tissue removal device2 does not need to be removed from the patient so that the user maysimply reorient the device 2 or move the device 2 to another locationwhere tissue is to be removed as described above. The method describedin connection with FIGS. 12-18 may also be accomplished with the deviceof FIGS. 2-11 in that the cutting element 10 may be used to transportthe tissue mass by itself. Such a method and use of the device 2 ofFIGS. 1-11 is expressly incorporated here.

Referring to FIGS. 19 and 20, another tissue removal device 2B is shownwherein the same or similar reference numbers refer to the same orsimilar structure. The tissue removal device 2B has a tubular element 4Bwhich is driven into tissue. The device 2B also has the cutting element10 which parts off the tissue in the tubular element 4B and the tissuechamber 30 which receives the tissue (see FIGS. 1 and 2). The cuttingelement 10 and/or tubular element 4B may be rotated to aid in cuttingthe tissue. The cutting element 10 may be rotated with the tubularelement 4 in the same direction or in opposite directions when partingoff the tissue which has entered the device 2B. The device 2B also hasthe first and second actuators 24, 26 which function in the same manneras the first and second actuators 24, 26 described above (also shown inFIGS. 1 and 2).

The device 2B also includes a transport element 60 which moves withinthe tubular element 4B and engages the tissue. The transport element 60may be any suitable element which engages and contacts the tissue mass.For example, the transport element 60 may be a wire 62 having a sharptip 64 which pierces the tissue. The wire 62 may be curved or helical sothat the wire 62 may be pivoted or rotated into engagement with thetissue. The transport element 60 may be advanced into the tissue beforethe tubular element 4B or may be driven into the tissue at the same timeas the tubular element 4A or even after the tubular element 4B has beendriven into the tissue.

Once the transport element 60 and the tubular element 4A are in theposition of FIG. 20, the transport element 60 moves proximally to carrythe tissue toward the tissue chamber 30. The transport element 60 mayalso be rotated in the same direction that was used to engage the tissuewhen transporting the tissue mass proximally to help maintain engagementwith the tissue. The tissue is transported proximally until the tissuecontacts the introducer 20 in the manner described above (see FIG. 11).The transport element 60 is then withdrawn thereby permitting the tissuemass to fall into the chamber 30. The transport element 60 may berotated when being withdrawn from the tissue so that the wire 62withdraws smoothly from the tissue. The transport element 60, tubularelement 4A and cutting element 10 are then moved back into position totake another tissue mass without removing the device 2B from the patientas described above.

Referring to FIG. 21, another tissue removal device 2C is shown whereinthe same or similar reference numbers refer to the same or similarstructure. The device 2C has a piercing element 82 which pierces thetissue. The piercing element 82 also has a deployable anchor 83 whichsecures the tissue to the piercing element 82. The anchor 83 may takeany suitable form. For example, the anchor 83 may be one or moreretractable barbs 84 which hold the tissue as shown in FIG. 21. Thebarbs 84 may be slightly curved to help hold the tissue on the piercingelement 80 but may take any other suitable shape. The anchor 82 may alsobe one or more wires 86 extending from the piercing element 82 as shownin FIG. 22 or may be an inflatable balloon 88 as shown in FIG. 23.

The device 2C also has the first and second actuators 24, 26 (see FIGS.1 and 2) which operate in the manner described above. The device alsohas a third actuator 27 which advances the piercing element 82 whenactuated. The piercing element 82 is then moved proximally after thethird actuator 27 is actuated again as described below to transport thetissue to the tissue chamber 30.

The device 2C may be operated in a number of different ways includingthe two now described. In one method, the piercing element 82 is driveninto the tissue before the tubular element 4 when the user actuates thethird actuator 27. The tubular element 4 is then driven over thepiercing element 82 when the user actuates the second actuator 26. Thepiercing element 82 is then moved proximally to tear the tissue from thesurrounding tissue. This step may be performed manually or by actuatingthe third actuator 27 again. The tissue is then transported proximallyby actuating the third actuator 27 again if the user has parted-off thetissue manually.

The piercing element 82 moves proximally until the tissue is over thetissue chamber 30 at which time the anchor 83 is automatically releasedby withdrawing the barbs 84 or wires 86 or deflating the balloon 88.Further retraction of the piercing element 80 withdraws the piercingelement 80 completely thereby permitting the tissue to fall into thetissue chamber 30 as described above in connection with the otherdevices 2, 2A, 2B. After the tissue has been deposited into the tissuechamber 30, the device 2C is ready to take another sample withoutremoval from the patient as described above.

In another method of operating the device 2C, the tubular element 4 isdriven into the tissue first and the piercing element 82 is then driveninto the tissue after the tissue has entered the tubular element 4. Theanchor 83 is then deployed to secure the tissue to the piercing element80. The tissue is then separated from the surrounding tissue andtransported to the tissue chamber 30 as described above.

The present invention has been described in connection with variouspreferred embodiments, however, it is understood that variousmodifications and alternative configurations are possible withoutdeparting from the scope of the invention. For example, the piercingelement may be adhered to the tissue in any other suitable manner otherthan using the deployable anchor.

1. A method of removing tissue using a coring-type biopsy device havingan open end rather than a lateral opening, comprising the steps of:providing a tissue removal device which is a coring-type device havingan open end rather than a lateral opening, the tissue removal deviceincluding a tubular element, a transport element, a tissue chamber and acutting element, the tubular element having an open end at a distal end,the transport element and the cutting element being positioned at leastpartially within the tubular element and being movable relative to thetubular element, the cutting element being movable relative to thetubular element between a stored position and a cutting position toseparate tissue cut by the tubular element from surrounding tissue;introducing the device into a patient; advancing the tubular element ina distal direction so that tissue enters the tubular element through theopen end, the tubular element being advanced so that tissue also entersthe transport element and is positioned within the transport element;cutting the tissue which has entered the open end by moving the cuttingelement relative to the tubular element from the stored position to thecutting position after the advancing step, the cutting elementseparating the tissue which has entered the open end from thesurrounding tissue to form a first tissue mass; and transporting thefirst tissue mass proximally with the transport element to the tissuechamber.
 2. The method of removing tissue using a coring-type biopsydevice having an open end rather than a lateral opening of claim 1,wherein: the providing step is carried out with the transport elementalso having an open end positioned proximal to the open end of thetubular element; and the advancing step is carried out with the tissueentering the transport element through the open end of the transportelement.
 3. The method of removing tissue using a coring-type biopsydevice having an open end rather than a lateral opening of claim 1,wherein: the transporting step is carried out with the cutting elementbeing in the cutting position and moving proximally with the transportelement when transporting the first tissue mass to the tissue chamber.4. The method of removing tissue using a coring-type biopsy devicehaving an open end rather than a lateral opening of claim 1, wherein:the transporting step is carried out with the distal end of the tubularelement remaining within the patient, the distal end of the transportelement moving to a position outside the patient when transporting thefirst tissue mass to the tissue chamber.
 5. The method of removingtissue using a coring-type biopsy device having an open end rather thana lateral opening of claim 1, wherein: the advancing step is carried outwith the cutting element being in the stored position, the cuttingelement being positioned between the tubular element and the transportelement when in the stored position.
 6. The method of removing tissueusing a coring-type biopsy device having an open end rather than alateral opening of claim 5, wherein: the cutting step is carried outwith at least one of the tubular element, the transport element and thecutting element rotating about a longitudinal axis of the tubularelement.
 7. The method of removing tissue using a coring-type biopsydevice having an open end rather than a lateral opening of claim 5,wherein: the cutting step is carried out with the cutting elementrotating about a longitudinal axis when cutting the tissue.
 8. Themethod of removing tissue using a coring-type biopsy device having anopen end rather than a lateral opening of claim 1, further comprisingthe step of: advancing the transport element over the tissue after thetissue has entered the open end of the tubular element.
 9. The method ofremoving tissue using a coring-type biopsy device having an open endrather than a lateral opening of claim 1, further comprising the stepof: providing an introducer having a sharp tip at a distal end, thetissue chamber being positioned to receive the first tissue mass whenthe transport element transports the first tissue mass proximally, theintroducer being movable between a first position in which the sharp tipextends beyond the open end and a second position in which the sharp tipis positioned away from the open end to expose the open end; theintroducing step being carried out with the introducer in the firstposition so that the sharp tip is positioned beyond the open end of thetubular element; and the transporting step including the step ofcontacting the first tissue mass with the distal end of the introducerwhile the first tissue is transported proximally and when the introduceris in the second position, wherein contact with the distal end of theintroducer stops the first tissue mass while the transport element isretracted thereby permitting the first tissue mass to fall into thetissue chamber.
 10. The method of removing tissue using a coring-typebiopsy device having an open end rather than a lateral opening of claim1, wherein: the cutting and transporting steps are carried outautomatically after the advancing step.